Heart Attack

A heart attack occurs when blood flow to the heart is interrupted. This deprives the heart muscle of oxygen, causing tissue damage or tissue death. Other names for heart attack include coronary attack, myocardial infarction, coronary thrombosis, and coronary occlusion.

Heart attack is an outcome of coronary artery disease (CAD), also called coronary heart disease. If too much plaque (fatty material) builds up in the coronary arteries, it can decrease the blood flow to the heart. If the plaque tears, a blood clot will form that may close off or severely narrow the artery. A heart attack occurs when the clot blocks the flow of blood to the heart. Cells in the heart start to die if they are without oxygen-rich blood for more than a few minutes. Heart attack also can occur if an artery that supplies the heart starts to spasm or contract. The spasm decreases or can stop blood flow. A heart attack can result from a severe spasm.

A heart attack requires immediate emergency medical care. If you think you are having a heart attack, call 911 immediately. At the emergency room, you will be hooked up to a cardiac (heart) monitor, so medical personnel can monitor your heart’s electrical activity. You will also undergo several different tests that will help the doctors to determine the appropriate treatments for you.

The following tests will likely be performed in the hospital:

Blood tests
—Certain substances are found in the blood within hours or days after a heart attack. Blood tests will be repeated every 6-8 hours to track certain enzymes (eg, troponins, creatine kinase). Progressive elevation indicates heart muscle damage.

Urine tests
—A sample of urine will reveal certain substances within hours or days after a heart attack.

Electrocardiogram (EKG)
—This test records the heart's activity by measuring electrical currents through the heart muscle. Certain abnormalities in the EKG occur when there is significant blockage of the coronary arteries and/or damage to the heart muscle. The EKG will be repeated to track the progression of these changes.

Echocardiogram
—High-frequency sound waves (ultrasound) are used to examine the size, shape, and motion of the heart. Echocardiograms can be performed using transducers held against the outside of the chest, or through a specialized transducer that is passed down the patient’s throat (transesophageal echocardiogram), allowing even better imaging of the heart and its blood vessels.

Coronary catheterization (angiography)
—In this procedure, x-rays are taken after dye is injected into the arteries. This is performed as part of a cardiac catheterization to look for abnormalities in the arteries that supply blood to the heart. You will be awake but sedated during the procedure. It may cause some discomfort.

Other tests that may be ordered include:

Magnetic resonance imaging (MRI)
—This test uses magnetic waves to make two- or three-dimensional pictures of the heart. It is not painful, however the test might be difficult for patients who are claustrophobic or very anxious. In this situation, a so-called “open MRI” might be indicated.

Nuclear scanning
—Radioactive material (such as thallium) is injected into a vein and observed as it is absorbed by the heart muscle. The areas with diminished flow (and therefore uptake of the radioactive material) show up as dark spots on the scan. This test aids in determining heart function.

Computed Tomography Electron-beam CT scan (CT angiography)
—This is a type of x-ray test that uses a computer to make detailed pictures of the heart, coronary arteries, and surrounding structures. This type of CT scan detects calcium deposits and cholesterol plaques in the coronary arteries. Based on this and other information, the doctor attempts to determine the risk of heart disease, including heart attacks. This test is not used to determine whether someone just had a heart attack. It can only be helpful in determining the risk of heart disease in some patients. The American Heart Association published guidelines in 2006, indicating those most likely to benefit from the procedure are patients at intermediate risk of coronary artery disease.

Stress test
—This test records the heart's electrical activity under increased physical demand. Stress tests can also be combined with echocardiography or with nuclear scanning. Patients who cannot exercise may be given a medication intravenously that simulates the effects of physical exertion.

In His Own Words: Living After a Heart Attack

As told to Debra Wood, RN

Bill, 72, never suspected he had a heart problem, until suffering a heart attack three years ago. While in the emergency room, the retired, South Carolina construction inspector's heart stopped and was jolted back to life. These days, he feels great and appreciates each day.

What was your first sign that something was wrong? What symptoms did you experience?

I was mowing the backyard when I had my first warning, which I didn't heed. A week later, I went to my daughter's home to get out of the path of a hurricane. While walking the dog, I felt the pain again. It subsided when I stopped walking. Once home again and unloading the car, it happened again. So I called the doctor. He made arrangements to meet me at the emergency room.

What was the diagnosis experience like?

An EKG in the emergency room showed up fine. They sent me home with some nitroglycerine and instructions to follow up with my doctor for a stress test. Two hours later, I knew I had a problem. The chest pain was severe and constricting. I felt nauseous. I took the nitroglycerine, but it didn't help. So I called EMS (emergency medical services). They took me back to the hospital. I went into cardiac arrest and was resuscitated. A heart catheterization showed blockages, so the doctor did bypass surgery. About six weeks later, while my wife and I were having breakfast, a pain hit me in the chest that surprised me a little. I knew what it was. After the EMS delivered me to the hospital, the doctors found the right coronary artery bypass had a blockage in it. The doctor attempted to open the artery up, but it was too calcified.

What was your initial and then longer-term reaction to the diagnosis?

It didn't scare me. I know people who had gone through a bypass surgery. So I figured I had a good chance of surviving it. I like to believe that I'm a positive thinker. You have to maintain a positive attitude. If you don't, it's like a strike–no–make that two strikes against you. I don't dwell on my heart. I don't have any complaints as long as I'm looking down at the blades of grass rather than facing up at the roots. God's letting me stay so I can spoil my five grandchildren.

How is a heart attack treated?

After the bypass surgery, I started a rehabilitation program at the hospital. The blockage set me back. But after that, I started rehab again. The rehab program taught me how to deal with it. They completely changed my eating habits and got me on a real good exercise program. I also take quite a few medications.

Did you have to make any lifestyle or dietary changes in response to the heart attack?

I used to eat a lot for the taste. I like cheese and anything with a lot of fat. The nutritionist at the rehab program had a one-on-one with me and gave me a fat budget to go by, which I have done. My wife decided to follow the diet too. We figured that we'd both eat that way.

Three times a week, I do a 50-minute workout, riding a stationary bike, stepping and rowing on the machines, walking on a treadmill and using six weight machines. I golf one day a week and exercise at home on another day.

Did you seek any type of emotional support?

A friend of mine was active in Mended Hearts, and he came to talk to me in the hospital after my bypass surgery. It was nice hearing from someone who had been through it. Now my wife and I go out and visit people as Mended Hearts volunteers. I have some friends who have been through a heart attack and have had a hard time. They come and talk to me.

Did the heart attack have any impact on your family?

We eat healthier. I'm still active and live a full life. A couple of times when I went into cardiac arrest, it scared my wife pretty badly.

What advice would you give to anyone living with a heart attack?

Diet and exercise–they are an absolute must if you want to live as long as possible. The nutritionists and rehab people know what they are doing. If they make suggestions, listen to them.

Interviews were conducted in the past and may not reflect current standards and practices in medicine. Talk to your doctor to learn more about how this condition is diagnosed and managed today and what treatment approaches are right for you.

You can lower your risk of heart attack by making modifications to your lifestyle. If you have already had a heart attack, or have several risk factors for heart disease that put you at high risk, your doctor may recommend certain medications to lower your risk of first or recurrent heart attack.

If You Smoke, Quit

Smoking can increase the amount of fatty material that collects in your arteries. In addition, nicotine contained in cigarette smoke makes your heart work harder. It narrows blood vessels and subsequently increases your heart rate and blood pressure. Also remember that secondhand smoking is detrimental to your health. Make sure you're not exposed to cigarette smoke. When you quit smoking, your risk of heart disease drops significantly within the first year.

Eat a Heart Healthy Diet

A diet low in saturated fat and cholesterol and rich in whole grains , fruits and vegetables will help lower cholesterol levels, blood pressure, and body weight—three heart attack risk factors. The American Heart Association (AHA) also recommends that you add fish, which contains omega-3 fatty acids , to your diet at least twice per week, and talk to your doctor about whether you should take omega-3 supplements.

If you are interested in eating healthier, your doctor can give you a referral to a registered dietician. She can create a meal plan that is right for you, ensuring that you get all of the nutrients that your body needs.

Exercise Regularly

Follow your doctor’s recommendations for physical activity. After a heart attack, he or she will likely refer you to a cardiac rehabilitation program, which will help you establish a life-long exercise plan and monitor your initial program. Choose exercises that you enjoy and that you will make a regular part of your day. Strive to maintain an exercise program that keeps you fit and at a healthy weight. For most people, this could include walking briskly or participating in another aerobic activity for at least 30 minutes per day.

Lose Excess Weight

Follow the dietary and exercise plan recommended by your doctor. Being overweight or obese is associated with a higher risk of heart attack, and losing weight lowers that risk. To lose weight, consume fewer calories than you expend. To maintain a healthy weight, eat an equal number of calories than you expend.One indicator of a healthy weight is body mass index. BMI of 25 and above is associated with high blood cholesterol, high blood pressure, and increased risk of heart disease.

Take Medications as Directed

If your healthcare provider has prescribed medications for your heart condition, take them exactly as directed and report side effects to your healthcare provider. Do not skip pills or stop taking them without consulting your healthcare provider.

Ask your doctor whether taking a daily aspirin is right for you. If you are at high risk of heart attack or have had a heart attack, aspirin may help prevent a future heart attack. Since aspirin therapy is not without risk, be sure to consult a health professional before taking an aspirin a day. If you had an angioplasty your doctor may prescribe other anticlotting drugs, like clopidogrel (Plavix), in addition to aspirin.

If you have had a heart attack, your doctor will consider prescribing certain classes of medication to reduce your risk of another heart attack. Your doctor will take into account your personal health history to determine if there are any reasons you should not take these medications. Beta blockers, which lower your blood pressure and heart rate, are generally prescribed for at least a year after a heart attack. People with high cholesterol will be placed on cholesterol lowering medications, like statins. Also, if you had a heart attack that significantly decreased your heart’s pumping capacity you may be given an ACE inhibitor.

Drink Alcohol in Moderation

Heavy drinking is associated with increased risk of heart attack. Moderate drinking may lower the risk of heart attack. Moderate drinking is one drink per day for women and two drinks per day for men. One drink equals 12 ounces of beer or 4 ounces of wine or 1 ounce of 100-proof spirits. In addition, alcohol may interfere with your medications. Make sure to discuss your alcohol intake with your healthcare provider.

When to Contact Your Doctor

If you experience any chest pain or discomfort, call 911 for emergency medical assistance

If you become short of breath

If you have pain in your arms, back, neck, jaw or stomach

If you develop new symptoms, such as nausea, sweating, lightheadedness, or dizziness

Description of services provided:The American Heart Association provides educational materials about heart attack, stroke, and other heart conditions. The national voluntary health agency’s mission is to reduce disability and death from cardiovascular diseases and stroke.

Description of services provided:Mended Hearts is affiliated with the American Heart Association. It provides support for heart patients, families, and caregivers through a network of local chapters. The organization helps heart patients adjust to changes brought about by their condition.

Description of services provided:The Heart and Stroke Foundation of Canada provides educational materials about heart attack, stroke, and other heart conditions. The national voluntary health agency’s mission is to reduce disability and death from cardiovascular diseases and stroke.

Last reviewed September 2012 by Brian Randall

Last updated Updated: 09/11/2012

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

A risk factor is something that increases your likelihood of getting a disease or condition.

It is possible to develop a heart attack with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of having a heart attack. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.

Some risk factors are lifestyle habits that you can modify. Other factors, like family history, are out of your control.

Lifestyle Factors

Smoking and Second-Hand Smoke

Cigarette smokers are twice as likely as nonsmokers to have a heart attack and are more likely to die from a heart attack than nonsmokers. Patients who continue to smoke in the presence of already established coronary heart disease are at increased risk for repeated myocardial infarction and sudden cardiac death.

While the risk is not as great as with smoking cigarettes, smoking other products or inhaling second-hand smoke increases the risk of heart disease and heart attack. Each year in America almost 40,000 deaths from heart disease are caused by passive smoking.

Physical Inactivity

Regular moderate to intense exercise improves heart function and promotes healthy arteries. It also helps to reduce high blood pressure, helps to lower cholesterol, as well as may help to prevent the development of diabetes. Also, there is strong evidence to suggest that regular physical exercise has beneficial effects for patients with already established heart disease.

Physical inactivity is at least responsible for a twofold increase in the risk of coronary events.

People who are usually inactive and then suddenly increase their physical activity are also at risk for having a heart attack.

Excessive Alcohol Intake

Drinking too much alcohol can increase blood pressure and lead to other heart problems. But drinking moderate amounts of alcohol seems to lower the risk of heart disease. Moderate means an average of one drink per day for women or two drinks per day for men.

It is important to remember, however, that moderate ingestion of alcohol poses several health risks. Based on currently available data, taking up regular consumption of alcohol is not encouraged for middle-aged men who do not drink or drink sporadically.

Cocaine Abuse

Cocaine abuse can lead to various health complications. Myocardial infarction (heart attack) is, however, one of the most frequently encountered. Cocaine is a very strong stimulant that causes rapid increase in blood pressure and heart rate; therefore, the drug places strong stress on the heart.

Certain Medical Conditions

Cholesterol Problems

Cholesterol is a waxy substance crucial to many body processes. But, cholesterol problems can lead to plaque buildup in the arteries. This, in turn, makes it more difficult for blood to flow to your heart. High levels of LDL (or "bad") cholesterol and low levels of HDL (or "good") cholesterol increase your risk of heart disease.

High Blood Pressure

When your blood pressure is high , your heart has to work harder than normal to pump blood through your body. This causes the heart to grow larger and weaker.

Obesity and Overweight

Even if you have no other risk factors, being obese or overweight will increase your risk of heart disease. It also adds to your chances of developing high blood pressure, high cholesterol, and type 2 diabetes , which are also risk factors for heart disease. Even losing as few as 10 or 20 pounds will lower your risk of heart disease.

Diabetes Mellitus

Diabetes mellitus is a metabolic disease in which the body does not produce or effectively use insulin. Even if you maintain good control of your blood sugar, your risk of heart disease is higher than someone who does not have diabetes.About 60% of patients with diabetes die of heart disease and/or stroke.

Even if you do not have diabetes, having high blood sugar levels can put you at an increased risk for heart attack and stroke.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions (elevated blood pressure, increased insulin levels, excess body fat around the waist or increased cholesterol levels) that occur together and significantly increase the risk of heart disease.

Other Factors

Increasing Age

Older adults are more likely to die of heart disease. About 80% of heart disease deaths occur in people age 65 or older.

Gender

Men tend to have heart attacks earlier in life than women. Women’s rate of heart attack increases after menopause but does not equal men’s rate. Even so, heart disease is the leading cause of death for both men and women.

Genetic Factors

You are more likely to develop heart disease if your parents have heart disease.

Racial and Ethnic Background

African Americans, Mexican Americans, American Indians, Native Hawaiians, and some Asian Americans are more likely than Caucasians to develop heart disease. African Americans are more likely to have severe high blood pressure, which is associated with heart disease. The other ethnic groups at increased risk have higher rates of obesity and diabetes, which are associated with heart disease.

The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

You may be screened to find out if you have risk factors for coronary artery disease before you begin to have any symptoms. Screening involves assessing your medical history and lifestyle habits that may increase or decrease your risk of having a heart attack.

Screening Tests

Blood pressure check —A blood pressure reading measures the amount of pressure in your arteries when the heart is pumping (the upper number) and when your heart is resting between beats (the lower number). For example, normal blood pressure is 120/80 or lower. Consistent blood pressure readings of 140/90 or higher are considered high blood pressure . A blood pressure test is quick and painless. A blood pressure cuff will be placed around your arm. Air will be pumped into the cuff to tighten it around your arm and then released while a healthcare professional listens with a stethoscope.

Cholesterol —Cholesterol levels are checked with a blood test. A blood sample will be taken from a vein in your arm. Cholesterol tests involve measuring total cholesterol, HDL (“good”) cholesterol, LDL (“bad”) cholesterol, and triglycerides.

The chart below lists healthy and unhealthy ranges for each type of cholesterol.

Total Cholesterol

Desirable

Less than 200 mg/dL* (5.2 mmol/L)

Borderline high

200-239 mg/dL (5.2-6.1 mmol/L)

High

240 mg/dL (6.2 mmol/L) and above

Low Density Lipoprotein (LDL)

Optimal

Less than 100 mg/dL (2.6 mmol/L)

Near or above optimal

100-129 mg/dL (2.6-3.3 mmol/L)

Borderline high

130-159 mg/dL (3.4-4.0 mmol/L)

High

160-189 mg/dL (4.1-4.8 mmol/L)

Very high

190 mg/dL (4.9 mmol/L) and above

High Density Lipoprotein (HDL)

Protective effect against heart disease

60 mg/dL (1.6 mmol/L) and above

Healthy range, but higher is better

40-59 mg/dL (1.0-1.5 mmol/L)

Major risk factor for heart disease

Less than 40 mg/dL (1.0 mmol/L)

Triglycerides

Normal

Less that 150 mg/dL (1.7 mmol/L)

Borderline high

150-199 mg/dL (1.7-2.2 mmol/L)

High

200-499 mg/dL (2.3-5.6 mmol/L)

Very high

500 mg/dL (5.7 mmol/L) and above

Note: These categories apply to adults aged 20 and older. *mg/dL = milligrams per deciliter of blood (mmol/L= millimoles per liter of blood)

Screening Guidelines

The National Guidelines Clearinghouse recommends adults up to age 64 receive blood pressure and cholesterol tests at least every three to five years. Adults over age 65 should have the screenings every one to two years.

Chest pain is the hallmark symptom of a heart attack. But not everyone having a heart attack experiences the same crushing pain. In particular, women, the elderly, or people with diabetes may experience no pain, or atypical symptoms. If you experience chest pain or any of the symptoms listed below in combination with chest discomfort, call emergency medical services (9-1-1) immediately. Do not delay. The more of these symptoms you experience together, the more likely it is that you may be having a heart attack. Do not drive yourself to the hospital. Emergency medical personnel can begin treatment before you reach the hospital.

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with heart attack. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.

Bring the list of current medications with you.

Write out your questions ahead of time, so you don't forget them.

Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.

Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.

Specific Questions to Ask Your Doctor

About Your Risk of Developing Heart Disease and Heart Attack

Based on my medical history, lifestyle, and family background, am I at risk for a heart attack?

How do I best prevent heart disease and heart attack?

How do I know if my blood pressure or cholesterol is high?

About Treatment Options

What are the risks and benefits of the various methods to reopen the artery?

What medications are available to help me?

What are the benefits/side effects of these medications?

Will these medications interact with other medications, over-the-counter products, or dietary or herbal supplements I am already taking for other conditions?

About Lifestyle Changes

How soon after my heart attack can I begin exercising?

What type of exercise is best?

How much should I be exercising?

How do I get started with an exercise program?

Are there other dietary changes I should make? How do I go about it?

Should I stop drinking alcohol?

How can I find help to quit smoking?

Do I need to lose weight? If so, how much?

How soon after my heart attack is it safe to have sex?

About Your Outlook

How do I know if my cholesterol and blood pressure are staying within healthy limits?

How often will you monitor my blood pressure and cholesterol levels?

How likely am I to have another heart attack?

How extensive is the damage to my heart? And how will that affect my quality of life?

The treatment and management of heart attack involves emergency medical care before and after reaching the hospital, medications, lifestyle changes and, possibly, a cardiac procedure or surgery.

The goals of treatment are to restore blood flow to the heart muscle and prevent another heart attack.

The Trials of Hypertension Prevention Collaborative Research Group. The effects of nonpharmacologic interventions on blood pressure of persons with high-normal levels. Results of the Trials of Hypertension Prevention, Phase 1. JAMA. 1992;267:1213.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY.
Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.